Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection.
Background: The urea breath test (UBT) is one of the most accurate methods of assessing Helicobacter pylori status. The predictive value of the test is, however, uncertain. This study was a serial, prospective analysis of the change over time of UBT values after first-, second- and third-line treatm...
| Publicado en: | Journal of Gastroenterology Vol. 43; no. 2; pp. 108 - 115 |
|---|---|
| Autores principales: | , , , |
| Formato: | clinical trial research Journal Article |
| Publicado: |
Springer Nature
2008
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105731330&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105731330 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09441174 EJ7 jtl: Journal of Gastroenterology issn: 09441174 maglogo: N pubinfo: dt: 2008 vid: 43 iid: 2 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 105731330 105731330 NLM18306984 2009827325 10.1007/s00535-007-2135-8 NLM18306984 105731330 ppf: 108 ppct: 7 formats: tig: atl: Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection. aug: au: Buzás GM Széles I Buzás, György M Széles, Ilona affil: Gastroenterology, Ferencváros Health Center, 1095, Budapest, Mester utca 45, Hungary sug: subj: Breath Tests Helicobacter Infections Diagnosis Helicobacter Infections Drug Therapy Helicobacter Pylori Adenosine Triphosphatase Antagonists and Inhibitors Adult Antiinfective Agents Therapeutic Use Clarithromycin Therapeutic Use Clinical Trials Crossover Design Drug Therapy, Combination Female Male Metals Therapeutic Use Metronidazole Therapeutic Use Middle Age Ranitidine Analogs and Derivatives Ranitidine Therapeutic Use Sulfur Compounds Therapeutic Use Urea Analysis Human Adult: 19-44 years Middle Aged: 45-64 years Female Male ab: Background: The urea breath test (UBT) is one of the most accurate methods of assessing Helicobacter pylori status. The predictive value of the test is, however, uncertain. This study was a serial, prospective analysis of the change over time of UBT values after first-, second- and third-line treatments of patients with failed eradication therapy.Methods: One hundred thirty-four duodenal ulcer patients with persisting H. pylori infection after first-line triple therapy were enrolled in a cross-over manner to receive either pantoprazole (40 mg twice daily), amoxicillin (1000 mg twice daily), and clarithromycin (500 mg) or ranitidine bismuth citrate (400 mg twice daily), metronidazole (250 mg twice daily), and clarithromycin (500 mg twice daily) for 7 days. Forty-one patients with failed second-line treatment were randomized to receive third-line quadruple therapies with pantoprazole + amoxicillin and tetracycline (500 mg four times daily) and either nitrofurantoin (100 mg three times daily) or bismuth subsalicylate (120 mg four times daily). Breath tests were performed 6 weeks after therapy. The delta(13)CO(2) values ( per thousand) after primary, secondary, and tertiary treatment were analyzed, and the correlation between pretreatment values and the rate of H. pylori eradication was assessed.Results: In patients with successful second-line treatment, UBT values decreased from 12.4 per thousand [confidence interval (CI), 9.7-15.7)] to 2.8 per thousand (CI, 0.9-2.5) (P=0.001), and in those with persistent infection, they increased from 13.2 per thousand (CI, 7.3-19.1) to 19.2 per thousand (CI, 13.4-25.0) (P=0.03). After a failed quadruple regimen, UBT values increased from 19.3 per thousand (CI, 16.2-22.4) to 25.8 per thousand (CI, 19.8-312.8) (P=0.03). The correlation between the pretreatment UBT values and the rate of eradication was negative for both second- and third-line therapies.Conclusions: Serial assessment showed that UBT values after successive treatments showed a marked tendency to increase over time in failed cases. The significance of this phenomenon must be further studied. It might indicate increased colonization, ongoing resistance, or urease gene overexpression. Higher pretreatment UBT values were associated with lower (<60%) eradication rates. In these cases, alternative/rescue therapies should be chosen. pubtype: Academic Journal doctype: clinical trial research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|